Infectious Etiologies and Patient Outcomes in Pediatric Septic Shock

Background. Septic shock remains an important cause of death and disability in children. Optimal care requires early recognition and treatment. Methods. We evaluated a retrospective cohort of children (age <19) treated in our emergency department (ED) for septic shock during 2008-2012 to investigate the association between timing of antibiotic therapy and outcomes. The exposures were (1) receipt of empiric antibiotics in <= 1 hour and (2) receipt of appropriate antibiotics in <= 1 hour. The primary outcome was development of new or progressive multiple system organ dysfunction syndrome (NP-MODS). The secondary outcome was mortality. Results. Among 321 patients admitted to intensive care, 48% (n = 153) received empiric antibiotics in <= 1 hour. These patients were more ill at presentation with significantly greater median pediatric index of mortality 2 (PIM2) scores and were more likely to receive recommended resuscitation in the ED (61% vs 14%); however, rates of NP-MODS (9% vs 12%) and hospital mortality (7% vs 4%) were similar to those treated later. Early, appropriate antibiotics were administered to 33% (n = 67) of patients with identified or suspected bacterial infection. These patients had significantly greater PIM2 scores but similar rates of NP-MODS (15% vs 15%) and hospital mortality (10% vs 6%) to those treated later. Conclusions. Critically ill children with septic shock treated in a children's hospital ED who received antibiotics in <= 1 hour were significantly more severely ill than those treated later, but they did not have increased risk of NP- MODS or death.